The clinical practice of sitting position with pencil point spinal needle for spinal anesthesia in emergency cesarean section

Abstract

Objective To study the effects of sitting position with pencil point spinal needle in spinal anesthesia for emergency Cesarean-section.Methods Four hundred ASA physical status of Ⅰ or Ⅱ parturients undergoing emergency cesarean section were divided randomly into four groups (100 cases each).Spinal anesthesia was performed with pencil pointed needle in sitting position in group A,or with pencil pointed needle in lateral position in group B,or with ordinary inclined plane needle in sitting position in group C,or with ordinary inclined plane needle in lateral position in group D.Spinal anesthesia was induced with 1.8 ml-2.2 ml of 5％ bupivacaine (9 mg-1 1 mg) following successful puncture.The parturients were escorted to wards when analgesia block level dissipated to T10 after operation.All patients must be in supine position for six hours.Postoperation follow-up lasted for three days.The frequency of puncture,puncture time,the rate of successful puncture,the time from skin incision to delivery.Intraoperation and postoperative complications were recorded.Results Compared with group B and D,the frequency of puncture were declined significantly in group A and C[group B(3.2±0.9) and D(4.1±0.4) vs group A(1.1±0.5) and C(1.2±0.6)],the rate of successful puncture were increased [group B (90％) and group D (92％) vs group A (100％) and group C (98％)],the time of puncture were shorter [group B (5.2±0.6) min and D (4.1±0.9) min vs group A (1.2±0.8) min and C (2.1±0.7) min],the time of performed spinal anesthesia were shorter [group B (7.1±0.5) rmin and D (6.2±0.8) min vs group A (3.4±0.7) min and C (4.3±0.6)min],the time from beginning puncture to skin incision were shorter [group B (15.2±6.3) min and D (17.1±4.4) min vs group A (10.4±0.5) min and C (11.3±0.7) min] (P＜0.05).Compared with group C and D,the rate of intraoperation hypotension were reduced in group A and B [group C(18％) and group D (20％) vs group A (8％) and group B (10％],There were no postdural puncture headache and low back pain in group A and B [group C(3％) and group D(4％) vs group A(0) and group B(0)](P＜0.05).Conclusions Spinal anesthesia with fine needle in sitting position is simple to perform and needs shorter time and fewer puncture times and has higher successful rate and fewer intraoperation and postoperation complications.It can be widely used in emergency cesarean section. Key words: Sitting position; Fine needle; Anesthesia, spinal; Cesarean-section